| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $13 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $37 | $55 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $21 | $21 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $27 | $27 | $27 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $5 | $8 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $34 | $37 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $151 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $34 | $37 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $45 | $60 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $34 | $37 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $37 | $290 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $45 | $60 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $151 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $46 | $62 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $272 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $46 | $62 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $37 | $260 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $262 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $821 | $1,047 | $1,274 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,230 | $2,236 | $2,241 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $4,528 | $4,548 | $4,569 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,135 | $3,657 | $5,369 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,869 | $4,929 | $5,989 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $514 | $955 | $1,395 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $631 | $1,092 | $1,553 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $25 | $43 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $13 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $15 | $22 |
| Cardiovascular stress test CPT 93015 • Cardiology | $166 | $170 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $57 | $85 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $184 | $194 | $205 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $247 | $387 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $30 | $95 | $169 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $165 | $321 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $150 | $389 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $467 | $474 | $482 |
| Left and right heart catheterization CPT 93452 • Cardiology | $571 | $578 | $586 |
| Left heart catheterization CPT 93458 • Cardiology | $382 | $582 | $783 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $447 | $1,367 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $113 | $206 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $94 | $185 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $94 | $201 | $273 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $33 | $58 | $83 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $26 | $48 | $70 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $90 | $141 | $193 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $116 | $116 | $116 |